Australian Medicare fraud revealed in new figures, 1,116 tip-offs so far this financial year

New figures show Medicare is being defrauded of hundreds of thousands of dollars each year.

Figures released to the ABC show the Federal Government has received more than 1,000 tip-offs of potential Medicare frauds to date this financial year.

It comes as debate continues over a proposal put to the Commission of Audit to charge a $6 co-payment for visits to the doctor, which would reduce costs to the health system.

The Department of Human Services says its hotline has received 1,116 Medicare-related tip-offs since July 1, 2013.

Officers have investigated 275 cases, which has translated into 34 cases submitted to the Commonwealth Department of Public Prosecutions and 12 convictions.

The value of those 12 cases adds up to an estimated $474,000, with fraudsters ripping off an average of almost $40,000 each.

Department figures suggest most of the frauds come from outside the doctor's office.

Ten of the 12 prosecutions this year were members of the public. One involved a medical practice staff member and one a practice owner.

"The Department of Human Services takes all allegations of fraud seriously and seeks to investigate where sufficient information is provided to do so,'' a spokeswoman said.

The annual review of doctors' use of Medicare, the Professional Services Review, showed at least 19 doctors were required to repay more than $1 million between them in 2012-13.

One doctor billed Medicare for seeing more than 500 patients in a day, and more than 200 patients on several other days.

Other cases uncovered by the ABC include:

Former police officer Matthew James Bunning has been charged with 146 Medicare frauds between 2011 and 2013. Investigators allege the 46-year-old removed Medicare slips from rubbish bins behind Medicare offices around Melbourne to produce forged receipts and illegally claimed more than $98,000 from the Government.

In January last year Korean student Myung Ho Choi was sentenced in a NSW district court to five years in prison for a series of fraud and identity theft charges that included receiving at least five paper boxes filled with blank Medicare cards intended for use in identity fraud.

In August last year NSW man Bin Li was sentenced in district court to seven years in prison for charges that included possessing almost 400 blank cards, including high quality Medicare cards, and machines for embossing cards.

Nilay Patel, a former US-based certified specialist in healthcare compliance and law tutor at Swinburne University of Technology, says the fraud figures are the "tip of the iceberg".

"There is a lot more that we do not know and that really comes from both camps from the patients and the medical service providers," he said.

He says Australia is falling behind the United States at preventing, detecting and prosecuting healthcare frauds.

"The safeguards [in Australia] are quite inadequate, the detection is more reactive that proactive and whatever proactive mechanisms that are there I think they are woefully underdeveloped," he said.

Relatively 'smallish' but unacceptable problem: Minister

Federal Government authorities say they do not think Medicare fraud is widespread.

Minister for Human Services Marise Payne says the number of Medicare frauds are low compared to the number of transactions.

"I think when you consider that we have 344 million Medicare transactions a year it is a relatively smallish [problem] but that doesn't mean it's acceptable," she said.

"One person committing a fraud effectively against the Australian taxpayer is one person too many."

Ms Payne says the department uses sophisticated data matching and analytics to pick up potential frauds as well as its tip-off hotline.

The merger of Medicare with Centrelink also allows the bureaucracies to better share information and leads.

"The work we have done in that area is paying dividends,'' Ms Payne said.

"There is more to do. The use of analytical data and risk profiling is highly sophisticated in the Centrelink space and we want to make sure we achieve the same levels in the Medicare space."

The Australian Federal Police says it does not routinely gather statistics on the number of fake or counterfeit Medicare cards.

However, a spokesman says detections of counterfeit Medicare cards are rare.

"Intelligence to date indicates that the majority of Medicare cards seized that are of sufficient quality, are used as a form of identity, not intentionally to defraud Medicare," a spokesman said.

A Customs and Border Protection spokeswoman says blank or fraudulent Medicare cards are not controlled under the Customs regulations and it is unable to provide seizure statistics.

The federal Ombudsman says he has not conducted any review or investigations into Medicare but did contribute to a 2009 inquiry into compliance audits on benefits.